CMAJ • August 29, 2006; 175 (5). doi:10.1503/cmaj.051356.
© 2006 CMA Media Inc. or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Research

Residence location and likelihood of kidney transplantation

Marcello Tonelli, Scott Klarenbach, Braden Manns, Bruce Culleton, Brenda Hemmelgarn, Stefania Bertazzon, Natasha Wiebe, John S. Gill for the Alberta Kidney Disease Network

From the Division of Nephrology and Transplant Immunology (Tonelli, Klarenbach, Wiebe) and the Division of Critical Care Medicine (Tonelli, Klarenbach), Department of Medicine, and the Department of Public Health Sciences (Tonelli), University of Alberta, Edmonton, Alta.; the Institute of Health Economics (Tonelli, Klarenbach, Manns), Edmonton, Alta.; the Department of Community Health Sciences (Manns, Hemmelgarn), the Division of Nephrology, Department of Medicine (Manns, Culleton, Hemmelgarn), and the Department of Geography (Bertazzon), University of Calgary, Calgary, Alta.; and the Division of Nephrology (Gill), St. Paul's Hospital, Vancouver, BC, and Tufts–New England Medical Center, Boston, Mass.

Correspondence to: Dr. Marcello Tonelli, Division of Nephrology and Transplant Immunology, University of Alberta, 7-129 Clinical Sciences Building, 8440–112 St., Edmonton AB T6B 2B7; fax 780 407-7878; mtonelli{at}ualberta.ca

Background: In a universal, public health care system, access to kidney transplantation should not be influenced by residence location. We determined the likelihood of kidney transplantation from deceased donors among Canadian dialysis patients living in 7 geographic regions. Within each region we also determined whether distance from the closest transplant centre was associated with the likelihood of transplantation.

Methods: A random sample of 7034 subjects initiating dialysis in Canada between 1996 and 2000 was studied. We used Cox proportional hazards models to examine the relation between residence location and the likelihood of kidney transplantation from deceased donors over a median period of 2.4 years.

Results: There were significant differences in the likelihood of kidney transplantation from deceased donors and predicted waiting times between the different geographic regions. For example, the adjusted relative likelihood of transplantation in Alberta was 3.74 (95% confidence interval [CI] 2.95–4.76) compared with the likelihood in Ontario (p < 0.001). These differences persisted after further adjustment for differences in the rate of deceased organ donation. Within regions, patients who resided 50.1–150 km, 150.1–300 km and more than 300 km from the closest transplant centre had a similar adjusted likelihood of receiving a kidney transplant as those who lived less than 50 km away.

Interpretation: The adjusted likelihood of undergoing a kidney transplant from a deceased donor varied substantially between geographic regions in Canada. In contrast, the likelihood of transplantation within regions was not affected by distance from the closest transplant centre.




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